近5年铜绿假单胞菌的临床分布及耐药性分析
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摘要
目的探讨铜绿假单胞菌的临床分布及耐药现状,为医院感染控制和临床抗菌药物合理应用提供理论依据。方法对2013～2017年门诊及住院患者送检标本中的病原菌进行培养、分离及鉴定,采用纸片扩散法、E-test法或全自动细菌分析仪测定抗菌药物的敏感性。结果共分离出3 930株铜绿假单胞菌,占所有病原菌的7.59%,占革兰阴性菌的12.93%;铜绿假单胞菌主要分离自痰液(52.72%)、引流液(10.59%)、分泌物(10.46%)、尿液(7.43%)、胆汁(7.40%)及全血(6.18%)。标本来源科室前3位为肝胆外科(22.19%)、中心ICU(12.26%)和神经外科(11.02%)。11种常用抗菌药物耐药性监测结果显示耐药率为:亚胺培南、美罗培南和氨曲南高于30%;哌拉西林和头孢他啶高于20%;庆大霉素、头孢吡肟、环丙沙星、左氧氟沙星和哌拉西林/他唑巴坦低于20%;阿米卡星低于10%。结论铜绿假单胞菌仍为医院感染的主要非发酵革兰阴性菌,碳青霉烯类抗生素的耐药率与全国最高水平相近,应加强抗菌药物规范化管理,减少碳青霉烯类抗生素的使用,降低铜绿假单胞菌的耐药率。
Objective To investigate the clinical distribution and drug resistance of Pseudomonas aeruginosa,and to provide the information for the rational use of antibiotics and control of nosocomial infection.Methods The samples which were collected from outpatients and inpatients from 2013 to 2017 were used for bacterial culture,isolation and identification.The antimicrobial susceptibility of bacteria was tested by using Kirby-Bauer test,E-test or automatic bacteria analyzer.Results A total of 3 930 strains of Pseudomonas aeruginosa were isolated,accounting for 7.59% of all pathogenic bacteria,accounting for 12.93% of Gram-negative bacteria.Pseudomonas aeruginosa was mainly isolated from sputum(52.72%),drainage fluid(10.59%),secretion(10.46%),urine(7.43%),bile(7.40%)and whole blood(6.18%).The top 3 departments were hepatobiliary surgery(22.19%),ICU(12.26%)and neurosurgery(11.02%).The results of antibiotic resistance surveillance showed that the resistance rates of imipenem,meropenem were more than 30%;the resistance rates of piperacillin and ceftazidime were more than 20%;the resistance rates of gentamicin,cefepime,ciprofloxacin,levofloxacin,piperacillin/tazobactam were less than 20%;the resistance rates of amikacin were less than 10%.Conclusion Pseudomonas aeruginosais still the main non-fermenting bacteria in nosocomial infection.The drug resistance rate of carbapenems is close to the highest level in China.It is necessary to strengthen the standardized management of antibiotics and reduce the use of carbapenems,then decrease the drug resistance of Pseudomonas aeruginosa.
Objective To investigate the clinical distribution and drug resistance of Pseudomonas aeruginosa,and to provide the information for the rational use of antibiotics and control of nosocomial infection.Methods The samples which were collected from outpatients and inpatients from 2013 to 2017 were used for bacterial culture,isolation and identification.The antimicrobial susceptibility of bacteria was tested by using Kirby-Bauer test,E-test or automatic bacteria analyzer.Results A total of 3 930 strains of Pseudomonas aeruginosa were isolated,accounting for 7.59% of all pathogenic bacteria,accounting for 12.93% of Gram-negative bacteria.Pseudomonas aeruginosa was mainly isolated from sputum(52.72%),drainage fluid(10.59%),secretion(10.46%),urine(7.43%),bile(7.40%)and whole blood(6.18%).The top 3 departments were hepatobiliary surgery(22.19%),ICU(12.26%)and neurosurgery(11.02%).The results of antibiotic resistance surveillance showed that the resistance rates of imipenem,meropenem were more than 30%;the resistance rates of piperacillin and ceftazidime were more than 20%;the resistance rates of gentamicin,cefepime,ciprofloxacin,levofloxacin,piperacillin/tazobactam were less than 20%;the resistance rates of amikacin were less than 10%.Conclusion Pseudomonas aeruginosais still the main non-fermenting bacteria in nosocomial infection.The drug resistance rate of carbapenems is close to the highest level in China.It is necessary to strengthen the standardized management of antibiotics and reduce the use of carbapenems,then decrease the drug resistance of Pseudomonas aeruginosa.
引文
[1]Bassetti M,Vena A,Croxatto A,et al.How to manage Pseudomonas aeruginosa infections[J].Drugs Context,2018,7:1-18.
[2]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:452-507.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-third informational supplement[S].2013:M100-S23.
[4]El Zowalaty M E,Al Thani A A,Webster T J,et al.Pseudomonas aeruginosa:arsenal of resistance mechanisms,decades of changing resistance profiles,and future antimicrobial therapies[J].Future Microbiol,2015,10(10):1683-1706.
[5]Koulenti D,Tsigou E,Rello J.Nosocomial pneumonia in27ICUs in Europe:perspectives from the EU-VAP/CAP study[J].Eur J Clin Microbiol Infect Dis,2017,36(11):1999-2006.
[6]Fernandez-Barat L,Ferrer M,De Rosa F,et al.Intensive care unit-acquired pneumonia due to Pseudomonas aeruginosa with and without multidrug resistance[J].JInfect,2017,74(2):142-152.
[7]朱德妹,汪复,胡付品,等.2010年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2011,11(5):321-329.
[8]胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[9]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[10]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[11]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[12]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[13]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[14]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[15]徐小芳,王蓉,叶顾萍,等.7 178株细菌耐药性监测[J].西北药学杂志,2016,31(3):319-323.
[16]颜令,王淑玲,徐兰兰,等.铜绿假单胞菌临床分布及耐药性的不均一性[J].中国感染控制杂志,2018,17(3):230-234.
[17]刘德华,单斌,杜艳,等.2014年中国云南地区铜绿假单胞菌耐药监测[J].国际检验医学杂志,2017,38(8):1066-1068.
[18]叶燕崧,梁杰昌,刘玉华.伤口感染病原菌分布及耐药性分析[J].西北药学杂志,2013,28(3):307-310.
[19]程古月,李俊,谷宇锋,等.世界卫生组织、欧盟和中国抗生素耐药性监测现状[J].中国抗生素杂志,2018,43(6):665-674.
[20]万永艳.铜绿假单胞菌对不同抗菌药物的耐药性与碳青霉烯类抗菌药物使用的相关因素分析[J].抗感染药学,2018,15(2):203-206.
[2]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:452-507.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing;twenty-third informational supplement[S].2013:M100-S23.
[4]El Zowalaty M E,Al Thani A A,Webster T J,et al.Pseudomonas aeruginosa:arsenal of resistance mechanisms,decades of changing resistance profiles,and future antimicrobial therapies[J].Future Microbiol,2015,10(10):1683-1706.
[5]Koulenti D,Tsigou E,Rello J.Nosocomial pneumonia in27ICUs in Europe:perspectives from the EU-VAP/CAP study[J].Eur J Clin Microbiol Infect Dis,2017,36(11):1999-2006.
[6]Fernandez-Barat L,Ferrer M,De Rosa F,et al.Intensive care unit-acquired pneumonia due to Pseudomonas aeruginosa with and without multidrug resistance[J].JInfect,2017,74(2):142-152.
[7]朱德妹,汪复,胡付品,等.2010年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2011,11(5):321-329.
[8]胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[9]汪复,朱德妹,胡付品,等.2012年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2013,13(5):321-330.
[10]胡付品,朱德妹,汪复,等.2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365-374.
[11]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[12]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[13]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[14]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[15]徐小芳,王蓉,叶顾萍,等.7 178株细菌耐药性监测[J].西北药学杂志,2016,31(3):319-323.
[16]颜令,王淑玲,徐兰兰,等.铜绿假单胞菌临床分布及耐药性的不均一性[J].中国感染控制杂志,2018,17(3):230-234.
[17]刘德华,单斌,杜艳,等.2014年中国云南地区铜绿假单胞菌耐药监测[J].国际检验医学杂志,2017,38(8):1066-1068.
[18]叶燕崧,梁杰昌,刘玉华.伤口感染病原菌分布及耐药性分析[J].西北药学杂志,2013,28(3):307-310.
[19]程古月,李俊,谷宇锋,等.世界卫生组织、欧盟和中国抗生素耐药性监测现状[J].中国抗生素杂志,2018,43(6):665-674.
[20]万永艳.铜绿假单胞菌对不同抗菌药物的耐药性与碳青霉烯类抗菌药物使用的相关因素分析[J].抗感染药学,2018,15(2):203-206.